Hi and apologies, I haven’t figured out how to be notified of a posting reply and just found this.
My experience was yes, using a phenomenology frame was very helpful getting clinical care folks focused on looking at QA/QM as something more than “busy work” getting in the way of doing important clinical work. For example, there was an issue with critically-ill homeless/immigrant patients in the public health system making f/u appts. after hospital discharge resulting in costly high readmission rates. The hospital service Attending/staff were directed to solve problem, met as a group & decided issue was patients simply didn’t know when/where their discharge appointments were and printing out better discharge appointment cards with explicit maps/directions & date/time of the f/u appointment was the answer. Problem solved, group dissolved, cards were promptly printed and given to discharge patients, end of story so they could get back to clinical care except that patients still didn’t show up and the readmission rate didn’t change.
As silly as it may seem, reframing the problem in terms of grounded theory/lived experience helped the medical staff realize they needed to actually interview/talk to patients to find out why they were missing discharge appointments instead of just assuming what the problem was. Of course the underlying issues varied pt. to pt. & could be generalized into basic themes like not having money for transportation, having disorganized cognitive follow-thru problems, not understanding language and importance of medical f/u, etc… I’m not sure if using phenomenological language gave medical staff permission to look deeper or better tools to examine the underlying issues or just slowed them down enough to think the problem through/outside of the box? The end result was we developed funding resources proposals for outreach discharge services w/patient advocates that saw/assessed critically-ill at risk patients before discharge to make specific plans to ensure they were seen in their specific Discharge Clinics, including accompanying them if needed. Success was measured by decreased early readmission rates, etc...which made folks feel good about the effort and the importance of doing good QA/QM.
Hi and apologies, I haven’t figured out how to be notified of a posting reply and just found this.
My experience was yes, using a phenomenology frame was very helpful getting clinical care folks focused on looking at QA/QM as something more than “busy work” getting in the way of doing important clinical work. For example, there was an issue with critically-ill homeless/immigrant patients in the public health system making f/u appts. after hospital discharge resulting in costly high readmission rates. The hospital service Attending/staff were directed to solve problem, met as a group & decided issue was patients simply didn’t know when/where their discharge appointments were and printing out better discharge appointment cards with explicit maps/directions & date/time of the f/u appointment was the answer. Problem solved, group dissolved, cards were promptly printed and given to discharge patients, end of story so they could get back to clinical care except that patients still didn’t show up and the readmission rate didn’t change.
As silly as it may seem, reframing the problem in terms of grounded theory/lived experience helped the medical staff realize they needed to actually interview/talk to patients to find out why they were missing discharge appointments instead of just assuming what the problem was. Of course the underlying issues varied pt. to pt. & could be generalized into basic themes like not having money for transportation, having disorganized cognitive follow-thru problems, not understanding language and importance of medical f/u, etc… I’m not sure if using phenomenological language gave medical staff permission to look deeper or better tools to examine the underlying issues or just slowed them down enough to think the problem through/outside of the box? The end result was we developed funding resources proposals for outreach discharge services w/patient advocates that saw/assessed critically-ill at risk patients before discharge to make specific plans to ensure they were seen in their specific Discharge Clinics, including accompanying them if needed. Success was measured by decreased early readmission rates, etc...which made folks feel good about the effort and the importance of doing good QA/QM.
Hope that’s a helpful exemplar?